Irene J Higginson1, Massimo Costantini. 1. Department of Palliative Care and Policy, King's College London, Weston Education Centre, London, United Kingdom. irene.higginson@kcl.ac.uk
Abstract
PURPOSE: To compare team assessments of end-of-life communication in three European countries, and to identify factors associated with problematic communication. PATIENTS AND METHODS: Three prospective cohort studies used similar standardized procedures, and included patients referred to palliative care services in the United Kingdom, Ireland, and Italy. Palliative team care staff assessed three components of communication in the last week of the patient's life-between the patient and family (or those close to them), between professionals and patient and family, and between professionals-using a validated measure. Univariate and multivariate analyses explored the data and tested for relationships between possible explanatory variables and communication. RESULTS: Data were collected on 1,326 patients, 416 in the United Kingdom, 411 in Ireland, and 499 in Italy. Mean age was 68 years (range, 19 to 95 years), 55% were male, and almost two thirds were married. Team members assessed that communication between patient and family was a moderate or severe problem in the last week of life for 30% to 40% of patients; 10% to 20% had moderate or severe problems recorded for the other two communication items. Problematic communication was associated with respiratory and breast cancers, a shorter time in care, and hospice death. It was also associated with greater spiritual need, need for care planning, and poorer patient and family insight (Spearman's rho > 0.4), but not especially with pain and symptom control, in both univariate and multivariate analyses, both within countries and for all data combined. CONCLUSION: Severe communication problems were reported by team assessments in up to 40% of patients at the end of life. A multiprofessional approach is needed to recognize and improve this.
PURPOSE: To compare team assessments of end-of-life communication in three European countries, and to identify factors associated with problematic communication. PATIENTS AND METHODS: Three prospective cohort studies used similar standardized procedures, and included patients referred to palliative care services in the United Kingdom, Ireland, and Italy. Palliative team care staff assessed three components of communication in the last week of the patient's life-between the patient and family (or those close to them), between professionals and patient and family, and between professionals-using a validated measure. Univariate and multivariate analyses explored the data and tested for relationships between possible explanatory variables and communication. RESULTS: Data were collected on 1,326 patients, 416 in the United Kingdom, 411 in Ireland, and 499 in Italy. Mean age was 68 years (range, 19 to 95 years), 55% were male, and almost two thirds were married. Team members assessed that communication between patient and family was a moderate or severe problem in the last week of life for 30% to 40% of patients; 10% to 20% had moderate or severe problems recorded for the other two communication items. Problematic communication was associated with respiratory and breast cancers, a shorter time in care, and hospice death. It was also associated with greater spiritual need, need for care planning, and poorer patient and family insight (Spearman's rho > 0.4), but not especially with pain and symptom control, in both univariate and multivariate analyses, both within countries and for all data combined. CONCLUSION: Severe communication problems were reported by team assessments in up to 40% of patients at the end of life. A multiprofessional approach is needed to recognize and improve this.